Category Archives: Medical Schools

Being pre-med is not easy and trying to go to medical school is difficult. When trying to achieve something so difficult, it is only natural for failure to play such a big part of it. Think about the NBA or NFL for example. Millions of people aspire to go on to play professional sports but if you look at the statistics, merely a handful of people actually get to live their dreams of participating in professional sports. Although compared to professional sports, pursuing medicine is not the same level of difficulty but nonetheless it is hard. If you take a look at the numbers it is pretty interesting:

There are more than 200,000 premed students in the United States. This number is not even accurate because many students may start out as premed but not declare it or decide after a semester or two that they no longer want to be premed. So this is a definite understatement and the number of students is actually a lot larger.

There are more than 48,000 premed students in the United States who are applying to allopathic (MD) schools. About ¼ of the students who started out as a premed student actually go on to apply to medical school.

There are more than 14,000 premed students in the United States who are applying to osteopathic (DO) schools.

Out of the almost 50,000 students that apply for medical school, about 20,000 students actually matriculate into medical school which is less than half of the number that apply.

Taking a look at the statistics you will notice that the odds are against you – 200,000 pre-med students to 20,000 students who actually start medical school. That is 1:10 so if you think about the hundreds of students in your Biology class, out of the 10 students next to you, only one of you will go on to medical school. That is a rough thing to hear and is sad but you have to remain positive if you do want to pursue medicine. The odds will forever not be in your favor but the only thing that is on your side is your motivation and desire to pursue medicine.

You might be thinking what is the point of trying to pursue medicine if the odds are against you. The point is that there are many things you can do in your life in which the odds will be against you. But if the thought of failure scares you more than the thought of not trying to pursue your dreams, then that is something you have to consider. For me, the thought of not trying to pursue medicine scared me more than anything and therefore applying to medical schools was the only natural choice. People will always try to scare you out of doing certain things because the probability of you being successful may be low. Just remember that someone has to end up in those positions and if you really want to you can beat the odds.

Obstetrics is the field of medicine which encompasses the care of a woman during pregnancy and childbirth. In that way it is very unique, as when assessing these patients, your actually also assessing another the child. Consequently, the approach to history taking in Obstetrics whilst similar to other fields of medicine, includes a number of additional components.

The following is a guide to taking an Obstetric History, that will ensure you miss none of the key components.

Presenting Complaint
What is the problem that brought you to the hospital/clinic?

Some common presenting complaints include;

◘ Bleeding

◘ Abdominal Pain

◘ Hypertension

◘ Physiological complaints due to pregnancy

The patient may also be presenting as part of standard antenatal care (as per your local guidelines).

History of Presenting Complaint
Often there will be overlap between the history of the presenting complaint and the history of the current pregnancy.

History of Current Pregnancy
The history of current pregnancy should ideally be considered by the different trimesters to date. This will be useful for understanding common issues that arise at each stage, and also determining appropriate antenatal care and management.

General Questions

◘ Last menstrual Period (LMP)

◘ Estimated delivery date and approximate Gestational Age.

◘ Any concerns about your pregnancy

◘ What are your expectations regarding your pregnancy

First Trimester

◘ Further details regarding menstrual history (as below)

◘ Was the Pregnancy planned?

◘ How was the pregnancy confirmed?

◘ Signs and symptoms of pregnancy.

◘ How/has the pregnancy been dated (e.g. dating Ultrasound Scan)?

◘ What tests and scans have you had to date?

◘ Current medical illnesses and medications.

Second Trimester

◘ Any problems during second 3 months?

o Bleeding, vaginal discharge, urinary problems and so on.

◘ Last visit to the doctor?

o Has an Ultrasound scan (e.g. morphology scan) been done?

o Blood tests to date?

o Blood pressure?

o Growth of foetus, placenta location.

Third Trimester

◘ Any issues after the first 6 months of your pregnancy?

o Bleeding, vaginal discharge, urinary problems, labour pain.

o Blood pressure

o Glucose

o Test results

◘ Any plans or ideas about method of delivery.

Past Obstetric HistoryGravidity: the number of times a woman has been pregnant, regardless of the outcome.Parity: the number of times a female has given birth to a baby.

There are many different methods and protocols by which Gravidity and Parity are denoted, please be aware of your local policy and documentation guidelines.

A woman who has never given birth is a nullipara, a nullip, or para 0.
A woman who has given birth two or more times is multiparous and is called a multip.
A woman in her first pregnancy and who has therefore not yet given birth is a nullipara or nullip. After she gives birth she becomes a primip.

A woman who has given birth once before is primiparous, and would be referred to as a primipara or primip.

Details of each pregnancy

◘ Dates of deliveries

◘ Length of pregnancies

◘ Singleton/twin and so on

◘ Induction of labour/Spontaneous

◘ Mode of Delivery

◘ Weight of babies

◘ Gender of babies

◘ Complications before, during and after delivery

Number of miscarriages, terminations and/or ectopics – with appropriate details.

◘ This question should be asked as some patients will not consider the above situations as pregnancy.

Any difficulties conceiving and any treatment/management to date for sub-fertility.

Past Gynaecological History
If it hasn’t been so already, you should first gain a Menstrual History as appropriate.

◘ 1st day of last menstrual period

◘ Duration and regularity of normal cycle

◘ Flow: heavy/light, clots, number of tampons/pads used

◘ Pain

Last Cervical Smear (Pap Smear): when and results.

Any Gynaecology Surgery?

◘ D&C

◘ Loop excision of transitional zone (LETZ)

◘ Previous C-Sections

Treatment or investigations for; ectopic pregnancy, pelvic inflammatory disease, infertility
This may be an appropriate place to take a Sexual History (see sexual history for further details).

Past Medical & Surgical History
Current or past illnesses

◘ Hypertension

◘ Diabetes

◘ Epilepsy

◘ Thyroid (hypo or hyper)

◘ Thromboembolic disease

◘ Asthma

Hospital Admissions: when, where and why.
Surgical procedures

◘ when, where, why and details concerning procedure

◘ abdominal or gynaecological procedures

◘ problems with anaesthesia

◘ problems with bleeding (requiring transfusion) or clotting

Vaccinations/immunisations up to date?

Current Medications & Allergies
Medications can be divided into prescribed medications and non-prescribed medications/herbal remedies. The latter should not be missed, and approached in non-judgemental way.
Allergic to any medications?

Free CME Online

Free online CME courses are usually sponsored by pharmaceutical companies or device manufacturers. In our listings, we try to identify the sponsoring organization or any affiliation the CME providers may have. As you would imaging, these courses usually deal with the specific pharmaceutical or medical device industry sold by the sponsoring company, but does not specifically identify brands. These courses generally meet the qualifying standards for Category 1 CME courses and therefore qualify for medical CME credits.

PRA Category 1 free online continuing medical education courses are offered by PRIME which are categorized into specialty practice and are augmented with free monthly case studies for physicians. Many of these meet relicensure requirements and are provided free without commercial support. Another major provider of free CME online courses is Medscape. These courses often take the form of “reports” and “highlights” from major medical meetings. The programs are generally of high quality and qualify for Category 1 CME credits. A wide variety of medical specialties (everything fromInternal Medicine CME to Psychiatry CME and Surgery CME) are covered.

There are also a small number of free CME courses provided by medical schools and training hospitals that can be accessed from anywhere. More often, though, CME courses provided by these institutions cost about $25/credit hour. For example, Harvard provides several online CME courses and charges between $20 and $50 per credit hour.

Free CME Course Lists

MedPix: Category 1 CME for physicians and CE for nursing professionals from the Uniformed Services University. One hour of category 1 CME credit is awarded for every 4 “case of the week” completed and after filling out an online survey.

An endocrinologist is a specialized physician. Endocrinology is a sub-specialty of internal medicine. In addition to understanding general medical treatment of the human body and primary care, endocrinologists complete additional training in treating the hormone system of the body, including ductless glands of internal secretion. Such glands include thyroid, adrenal, pituitary, pancreas, and glands in reproductive organs of men and women.

Some of the most common issues that endocrinologists help to diagnose, treat or manage is diabetes, irregular metabolism, growth disorders in children, weight issues, hypo- and hyper-thyroidism, and more.

How to Become an Endocrinologist – Education and Training Requirements:

Endocrinologists are physicians, and therefore they must obtain a medical degree (M.D., or D.O.) from an accredited medical school and complete all of the requirements to practice medicine as a licensed physician. In the United States that includes:

4 years of undergraduate coursework resulting in a Bachelor’s Degree.

4 years of medical school resulting in a medical degree from an osteopathic (D.O.) or allopathic (M.D.) program.

3 years of residency training in internal medicine.

2-3 years of required fellowship training in endocrinology (and nutrition if a 3-year fellowship).

Licensing and Certification for Endocrinologists in the United States:

Endocrinologists must complete the same credentialing as other physicians practicing in the United States,This includes passing all three parts of theUSMLE (United States Medical Licensing Exam), and obtaining a state medical license in the state he or she wishes practice.

Most practice opportunities will require an endocrinologist to be board certified in both specialties of Internal Medicine and Endocrinology.

In order to keep their license current, like all physicians, endocrinologists must successfully complete the required hours of continuing education (CME) and have their license renewed every 7-10 years depending upon state and specialty requirements. Also, the doctor must maintain an ethical standard of practice, as some disciplinary actions can cause a physician to lose his or her medical license if they are severe infractions.

Typical Workweek and Practice Characteristics:

Most endocrinologists will work over 40 hours per week in an medical office setting primarily, as they do not perform many, if any surgeries or invasive procedures. Endocrinologists conduct office exams and consultations with patients, order tests and interpret the results, and then decide on the course of treatment which may involve medication, dietary changes, or surgery. If the patient needs surgery, most likely the endocrinologist would then refer the patient to an appropriately trained surgeon to perform the operation.

Endocrinologists may be employed by a hospital or group, in a single- or multi-specialty practice, or they may own their own practice or be a partial owner of a group practice as opposed to being an employee.

Many of the patients treated by endocrinologists may be referred to the endocrinologist by another physician such as a primary care doctor, obstetrician/gynecologist,gastroenterologist, etc. Therefore endocrinologists’ work is very consultative in nature and they must be adept at working as part of a treatment team including other physicians, as well as nurses and allied health professionals.

Annual Income and Job Outlook for Endocrinologists:

According to the Medical Group Management Association (MGMA) 2013 Physician Compensation and Production Survey, the average annual income for an endocrinologist is $241,565. However, compensation can vary widely from $186,000 at the 25th percentile of earners, to $356,000 at the 75th percentile.

As with all physicians, outlook for endocrinologists is strong. According to the American Diabetes Association, nearly ten percent of all people in the U.S. have some form of diabetes, and many more are pre-diabetic. This, combined with the growth in the population, and the increasing age of the nation’s population, will continue to drive demand for endocrinologists.

Additionally, because demand for primary care physicians is going to be extremely high in the wake of the Affordable Care Act, endocrinologists always have that as an option if for any reason they can’t build a large enough practice of endocrinology patients solely. In other words, worst-case scenario, if demand were to diminish, which it is not expected to, endocrinologists could incorporate some primary care patients into their practices to help maximize their volume if needed.

1. Take Hard Classes

You’re paying good money for an education, make sure you get one. There will be classes that are required for your major, of course, but you will have a fair number of electives as well. Don’t take classes simply to accrue credits. Take the classes that really teach you something.

Be passionate about learning.

I once had an advisor that said to me when I expressed fear of a difficult class, “Do you want to get an education or not?”

2. Show Up, Every Time

Make your classes your highest priority.

If you’ve got children, I understand that this isn’t always possible. Children should always come first. But if you don’t show up for your classes, you’re not getting that education we discussed in No. 1.

Make sure you’ve got a good plan for seeing that your children are cared for when you’re scheduled to be in class, and when you need to study. It really is possible to raise children while you’re going to school. People do it every day.

3. Sit in the Front Row

If you happen to be shy, sitting in the front row can be very uncomfortable at first, but I promise you, it’s one of the best ways to pay attention to everything being taught. You can hear better. You can see everything on the board without having to crane your neck around the head in front of you.

You can make eye contact with the professor. Don’t underestimate the power of this. If your teacher knows you’re really listening and that you care about what you’re learning, he or she will be extra willing to help you. Besides, it’ll feel like you’ve got your own private teacher.

4. Ask Questions

Ask questions immediately if you don’t understand something. If you’re in the front row and have been making eye contact, your instructor probably already knows by the look on your face that you don’t understand something. A polite raising of your hand is all you need to do to indicate you’ve got a question.

If it isn’t appropriate to interrupt, make a quick note of your question so you don’t forget, and ask later.

Having said this, don’t make a pest of yourself. Nobody wants to hear you ask a question every 10 minutes. If you’re completely lost, make an appointment to see your teacher after class.

5. Create a Study Space

Carve out a place at home that is yourstudy space. If you’ve got a family around you, make sure everyone understands that when you’re in that space, you’re not to be interrupted unless the house is on fire.

Create a space that helps you make the most of your study time. Do you need absolute quiet or do you prefer to have loud music playing? Do you like working at the kitchen table in the midst of everything or do you a quiet room with the door shut? Know your own style and create the space you need.

6. Do All the Work, Plus More

Do your homework. Read the assigned pages, and then some. Plug your topic into the Internet, grab another book at the library, and see what else you can learn about the subject.

Turn your work in on time. If extra credit work is offered, do that too.

I know this takes time, but it’ll ensure you really know your stuff. And that’s why you’re going to school. Right?

7. Make Practice Tests

While you’re studying, pay attention to the material you know will be on a test and write a quick practice question. Start a new document on your laptop and add questions as you think of them.

When you’re ready to study for a test, you’ll have a practice test ready. Brilliant.

8. Form or Join a Study Group

A lot of people study better with others. If that’s you, form a study group in your class or join one that’s already organized.

There are lots of benefits to studying in a group. You have to be organized. You can’t procrastinate. You have to really understand something to be able to explain it out loud to someone else.

9. Use One Planner

I don’t know about you, but if I had a separate calendar for work, school and life, I’d be a complete mess. When everything in your life is on one calendar, in one planner, you can’t double-book anything. You know, like an important test and a dinner with your boss. The test trumps, by the way.

Get a great calendar or planner with enough room for several daily entries. Keep it with you at all times.

10. Meditate

One of the best things you can do to improve your entire life, not just school, is meditate. Fifteen minutes a day is all you need to feel calm, centered and confident. If you don’t know how,

Meditate any time, but 15 minutes before you study, 15 minutes before class, 15 minutes before a test, and you’ll be amazed at how well you can perform as a student.

In the U.S., more people are being treated by diseases that can easily be prevented such as smoking, obesity, and heart failure, just to name a few. In 2008, the Centers for Disease Control and Prevention (CDC) reported that five diseases account for more than 65 percent of the deaths of American men. However, when people finally go see the doctor for their ailments, all the doctor can do is attempt to offer temporary treatments.

Over the years there has been a lack of education about nutrition and diet in medical schools, and unfortunately, that trend continues in many of today’s medical curriculum. In an article by David Freudberg, “Medical Students Discuss ‘Red Flags’ About the Future of Health Care”, he says that medical school has not trained doctors to help patients with lifestyle choices.

Ask doctors how to treat diabetes, and they can give you a number of answers, but ask them exactly what can be done to prevent this disease, they may draw a blank.

A medical student’s answer to this is that the course of study for medical school is already daunting and stressful without having to add more classes on diet and nutrition. I’m pretty sure there are classes that are not exactly a necessity. For premed courses, you could probably cut out a chemistry or physics class and replace it with a nutrition class. Classes that have a practical application in the real world of medicine should have precedence over a traditional curriculum.

If you’re a doctor, it’s important to remember that you are not just someone there to just prescribe a pill and send the patient on their merry way. You also have to consider yourself a consultant, and many of your patients will have questions about what they should or shouldn’t eat so that they can be healthier. And even if they don’t ask, I believe it’s your duty to share your knowledge on actions they can take to prevent diseases. Having a good rapport and communication with patients can help prevent medical malpractice.

I also believe that hospitals or any organization employing healthcare professionals should provide ongoing classes or workshops on the latest information about diets and nutrition. We have to remember that doctors have to be good role models and eat healthy too. How can patients look to doctors as authority figures and follow their advice if doctors don’t maintain a healthy lifestyle as well?

Declining reimbursements, increased overhead, implementation of the Affordable Care Act, the rush to litigation are but a few of the reasons to “sweat the small stuff” in the medical arena. If you don’t think you need to pay attention to the details when it comes to making your patients happy as well as healthy, think again. If ever there was a time to mind your medical manners, it’s now.

Patient satisfaction is becoming the key phrase in healthcare. That is not to say that patient outcomes are no longer important. However, it is now obvious that there is a direct correlation between how patients are treated personally and how they are treated clinically.

Using good manners and following the rules of proper etiquette can make an incredible difference in how physicians and their staff are viewed by their patients. If patients feel valued by their physicians and have positive interactions with the staff, they are most likely to become longtime loyal customers. Yes, patients are customers, too.

Let me suggest twelve simple rules of etiquette that can have a positive effect on patient relations and outcomes:

1. Stop, look and listen. This rule does not simply apply to the train rumbling down the tracks. It has great value in a physician’s office. While doctors can rarely spare as much time with patients as they once did, the people they treat need not wonder if their doctor is wearing a stop watch or has set an alarm on his smart phone or on his new Apple watch. Slow down. In some instances, stop.

2. Make eye contact with patients while talking with them. Focus on the patient and not on the computer screen. If your computer is placed in such a way that you must turn away from the patient, get a laptop or reconfigure the computer’s placement.

3. Listen. What a novel idea. When you ask the critical questions, pay attention to the answers. Use good listening skills such as nodding at the person, repeating what you have heard and paraphrasing what was said. Avoid the urge to interrupt or finish the patient’s sentence. You could miss valuable information.

4. Practice professional meeting and greeting. Make your introduction warm and friendly.

5. Smile and make eye contact. This helps to put people at ease and makes them feel welcome and valued.

6. Use the patient’s name as soon as you can while adhering to patient privacy laws. Address people by their title and last name until you receive permission to call them by their first name.

7. Introduce yourself even if you are wearing a name badge, which you should be. Don’t forget to give your title or position so patients will know if they are speaking to a nurse, a technician or a housekeeper.

8. Let the patient know what is going to happen next. For example, “I am going to get your vital signs now. Then you may have a seat in the waiting area until the doctor is ready to see you.” That is something that is done in my own doctor’s office. The usual custom is to tell the patient that you will be leaving the room and that the doctor will be in shortly.

9. Someone should keep track of how long the patient has been waiting in the exam room and check back from time to time. Even a prolonged wait will pass more quickly if the patient sees other humans from time to time.

10. Dress like a professional. Most physicians offer a professional appearance if for no other reason than that they wear a white coat to hide their sins. The office staff is another issue. Some employees wear whatever they choose. Others are required to dress in uniforms. The result is that there is a wide variety in office attire-some of it neat and professional and the other not so much.

11. Dress policies should be put in place and enforced by the officer manager. Lack of attention to office attire can give patients a poor impression and even lead to doubt as to the level of care they will receive.

12. Keep office differences under wraps. Not everyone in the office is best friends with or even likes their co-workers. This should not be the patient’s problem. If employees cannot resolve the trouble between themselves, they need to take up their problem with the office manager, not gossip to others in the office and definitely not make their issues public.

Invest time and money in training physicians and medical staff in the importance of soft skills. While interpersonal skills may not seem as critical as clinical skills in a physician’s practice, without them there soon may be no patients to treat. People have choices in where they go for their medical care; you want that to be in your office.